POS1517 MICROANGIOPATHY, INDEPENDENT RISK FACTOR FOR DAMAGE ACCRUAL IN ANTIPHOSPHOLIPID SYNDROME: A RETROSPECTIVE MULTI-CENTER STUDY
Authors: A. Hoxha, G. Carli, A. Calligaro, T. Del Ross, M. Favaro, M. Tonello, A. Tosetto, A. Doria, P. Simioni
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Antiphospholipid syndrome is characterized from venous, arterial and small vessels thromboembolic events leading to significant morbidity and mortality despite current treatments. Albeit, the acute diseases manifestations of antiphospholipid syndrome are well known, data on damage accrual are still lacking. <h3>Objectives</h3> To assess the frequency of accrual damage in antiphospholipid syndrome (APS) and to evaluate the association with different laboratory and clinical APS subsets. <h3>Methods</h3> Medical records of 274 patients, 231 (84.3%) female and 43 (15.7%) males with a mean (±SD) age at diagnosis of 37.8 (±11.5) years, followed prospectively from 1990 to 2021, were reviewed. <h3>Results</h3> Ninety-six (35%) presented pregnancy morbidity alone, 140 (51.1%) thrombosis alone and 38 (13.9%) both thrombosis and pregnancy morbidity. A single, double or triple antiphospholipid antibodies (aPL) positivity was registered, respectively in, 82 (29.9%), 78 (28.5%) and 114 (41.6%) of the patients. Following a mean (±SD) follow up of 208.4 (±91.7) months, a total of 58 (21.2%) organ damage accrual was recorded. This included neurological damage in 19 (32.8%) patients, hemiparesis in 9, epilepsy in 7 and cognitive dysfunction/dementia in three cases, cardiac valvopathy in 4 (6.9 %) patients of which 3/4 (75%) require valve replacement with mechanical valve in two cases and bioprosthetic in one. Chronic heart failure was found in 4 (6.9%) patients, chronic renal failure in 15 (25.9%), amputation due to peripheral arterial thrombosis in 5 (8.6%), visual loss in 2 (3.4%), post thrombotic syndrome in 6 (10.3%), adrenal insufficiency in one (1.7%). Some of the patients present more than one organ disfunction. Both thrombotic and thrombotic and pregnancy morbidity subsets were significantly associated with a higher rate of damage accrual compared with pregnancy morbidity alone, respectively p&lt;0.0001 (OD 40.7; 95% CI: 6.9-418.8) and p&lt;0.0001 (OD 61.9; 95% CI 10.5-659.7). Moreover, the presence of microangiopathy as well as the presence of both venous and arterial thrombosis were significantly associated with damage accrual, respectively (p&lt;0.0001, OD 10.99; 95% CI 5.7-21-36) and (p=0.001). Regarding laboratory subsets, triple aPL positivity was significantly associated with a higher rate of damage accrual compared to single and double aPL, respectively, p&lt;0.0001 (OD 9.6; 95% CI: 3.7-23.5) and p&lt;0.0001 (OD 4.8; 95% CI: 2.2-10.81). At the multivariate analysis only microangiopathy was an independent risk factor for damage accrual (p=0.001). <h3>Conclusion</h3> Overall, our data show a higher frequency of damage accrual in APS patients. Microangiopathy was independent risk factor for damage accrual. These findings should be in mind when counselling APS patients and might help guide clinicians in therapeutic decision. <h3>References</h3> [1] Cervera R, Serrano R, Pons-Estel GJ, et al. Ann Rheum Dis 2015;74:1011–1018. doi:10.1136/annrheumdis-2013-204838 [2] Taraborelli M, Reggia R, Dall'Ara R et al. J Rheumatol 2017;44:1165–1172. doi:10.3899/jrheum.161364. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.